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MicroRNA-210 as a Novel Therapy for Treatment of Ischemic Heart Disease

Originally published 2010;122:S124–S131


    Background—MicroRNAs are involved in various critical functions, including the regulation of cellular differentiation, proliferation, angiogenesis, and apoptosis. We hypothesize that microRNA-210 can rescue cardiac function after myocardial infarction by upregulation of angiogenesis and inhibition of cellular apoptosis in the heart.

    Methods and Results—Using microRNA microarrays, we first showed that microRNA-210 was highly expressed in live mouse HL-1 cardiomyocytes compared with apoptotic cells after 48 hours of hypoxia exposure. We confirmed by polymerase chain reaction that microRNA-210 was robustly induced in these cells. Gain-of-function and loss-of-function approaches were used to investigate microRNA-210 therapeutic potential in vitro. After transduction, microRNA-210 can upregulate several angiogenic factors, inhibit caspase activity, and prevent cell apoptosis compared with control. Afterward, adult FVB mice underwent intramyocardial injections with minicircle vector carrying microRNA-210 precursor, minicircle carrying microRNA-scramble, or sham surgery. At 8 weeks, echocardiography showed a significant improvement of left ventricular fractional shortening in the minicircle vector carrying microRNA-210 precursor group compared with the minicircle carrying microRNA-scramble control. Histological analysis confirmed decreased cellular apoptosis and increased neovascularization. Finally, 2 potential targets of microRNA-210, Efna3 and Ptp1b, involved in angiogenesis and apoptosis were confirmed through additional experimental validation.

    Conclusion—MicroRNA-210 can improve angiogenesis, inhibit apoptosis, and improve cardiac function in a murine model of myocardial infarction. It represents a potential novel therapeutic approach for treatment of ischemic heart disease.

    Ischemic heart disease is the number 1 cause of morbidity and mortality in the United States owing to aging, obesity, diabetes, and other comorbid diseases. One potent therapeutic approach for ischemic heart disease is to reduce oxygen consumption, inhibit cardiomyocyte apoptosis, increase coronary flow, and induce revascularization. MicroRNAs (miRNAs), representing approximately 1% of the eukaryotic transcriptome, is an evolutionarily conserved family of noncoding RNAs of 20 to 22 nucleotides that negatively regulate the expression of protein-coding genes through translational inhibition and RNA decay. miRNAs are involved in diverse biological progresses, including cellular differentiation, proliferation, angiogenesis, and apoptosis.1 To date, 721 miRNAs have been discovered in human and 597 miRNAs in the mouse according to the miRBase Sequence Database Release 14 ( miRNAs can regulate approximately 30% human protein-coding genes.2 Importantly, the successful suppression of murine liver cancer by systemic delivery of miR-26a suggests the potential of using miRNAs as a novel therapeutic tool.3

    In the cardiovascular field, miRNAs have also been implicated as a significant factor in various physiological and pathological diseases.4 For example, miR-21 expression is significantly downregulated in the infarcted heart but upregulated in border areas, hence serving a possible protective role in the early phase of acute myocardial infarction.5 Recently, several groups have reported miR-210 as 1 of several hypoxia-induced miRNAs critical for cell survival and angiogenesis.6 Huang et al demonstrated that miR-210 is hypoxia inducible factor-1α-dependent and provided further insight into its functional role during tumor initiation.7 They showed that increasing miR-210 expression gives the tumor cells an opportunity to prevail under initial stressful conditions.

    In this study, we hypothesize that miRNA may play a significant role in regulating angiogenesis and apoptosis after myocardial infarction. We demonstrate for the first time that delivery of miR-210 through a nonviral minicircle vector in the ischemic heart can improve heart function by promoting angiogenesis and inhibiting apoptosis. Our results show miR-210 may lead to a novel therapy for ischemic heart disease.

    Materials and Methods

    Cell Culture, Cell Transduction, and Hypoxic Conditions

    293FT cells (Invitrogen) were used to generate recombinant replication-deficient lentivirus used for in vitro assays as described.8 Mouse HL-1 cardiomyocytes were cultured in Claycomb media supplement 10% fetal bovine serum (Sigma), 0.1 mol/L norepinephrine (Sigma), 2 mmol/L l-glutamine (Invitrogen), and penicillin/streptomycin (Invitrogen) in a humidified 5% CO2 incubator at 37°C. Hypoxia was achieved by placing cells in a hypoxia chamber filled with 5% CO2, 1% O2, and 94% N2 at 37°C. At different time points during hypoxic treatment, cells were harvested for analysis of miR-210 levels. Angiogenesis factor antibody array (Panomics Inc, Fremont, Calif) was used to investigate the angiogenic potential of miR-210. Apoptosis assays were performed after 48 hours of transduction with lentivirus carrying miR-210 precursor (Pre-210), lentivirus carrying miR-scramble (Pre-Scr), lentivirus carrying antisense of miR-210 (Anti-210), and lentivirus carrying antisense of miR-scramble (Anti-Scr) using a Caspase-Glo 3/7 Assay (Promega) according to the manufacturer’s instructions. The caspase activities for all samples were normalized to that of an equal protein amount. The data obtained are from experiments performed in triplicate.

    miRNA Microarray and Data Analysis

    Microarray assay was performed using a service provider (LC Sciences, Houston, Texas). The assay started with a 4-μg total RNA sample. Hybridization was performed overnight on a microfluidic chip consisting of chemically modified nucleotide coding segment complementary to target microRNA (miRBase 13.0) or other control RNA. Fluorescence images were collected using a laser scanner and digitized using Array-Pro image analysis software. Raw data matrix is then subtracted by the background matrix. Data adjustment includes data filtering, Log2 transformation, gene centering, and normalization. A 2-sample t test was conducted for statistical analysis.

    Preparation of Minicircle DNA

    Minicircles are the product of site-specific intramolecular recombination between the attB and attP sites driven by bacteriophage ΦC31 integrase (Supplemental Figure I; available at The DNA fragment containing firefly luciferase and enhanced green fluorescent protein (MC-LG), mir-210 precursor (MC-210), or miR-scramble (MC-Scr) were bluntly ligated between attB and attP sites of p2øC31 minicircle plasmid. The minicircle DNA plasmid (gift from Dr Mark Kay, Stanford) was produced as described previously.9 Briefly, Escherichia coli Top10 (Invitrogen) was transformed by parental plasmids. A single colony of the transformants was grown at 37°C overnight. Then 800 mL of bacterial culture was spun down in a centrifuge at 1500 g for 15 minutes at room temperature. The pellet was resuspended with 200 mL of fresh LB broth (pH 7.0) containing 1% L-(+)-arabinose. The resuspended bacteria were incubated at 30°C at 250 rpm for 2 hours. Subsequently, 300 mL of fresh LB broth (pH 8.0) containing 1% L-(+)-arabinose was added and the bacteria were incubated for additional 2 hours at 37°C. Minicircle DNA was isolated using plasmid purification kits from Qiagen (Valencia, Calif).

    Surgical Model of Mouse Myocardial Infarction

    Adult female FVB mice (10 weeks old) were purchased from Charles River Laboratories (Wilmington, Mass). Ligation of the mid-left anterior descending (LAD) artery was performed by a single experienced microsurgeon (X.W.). Myocardial infarction was confirmed by myocardial blanching and electrocardiographic changes. After 15 minutes, the animals were then injected intramyocardially with 25 μg of minicircles carrying miR-210 precursor (MC-210) or minicircles carrying Scramble (MC-Scr; n=15 per group). Injections were made near the peri-infarct region at 3 different sites with a total volume of 25 μL using a 29-gauge Hamilton syringe. The third group was performed sham, which underwent surgery but not LAD ligation (n=15). Study protocols were approved by the Stanford Animal Research Committee.

    Echocardiographic Analysis of Left Ventricular Function

    Echocardiography was performed before (Day −7) and after (Week 2, Week 4, and Week 8) the LAD ligation. A Siemens-Acuson Sequioa C512 system equipped with a multifrequency (8 to 14 MHZ) 15L8 transducer was used by an investigator (M.H.) blinded to group designation. Analysis of the M-mode images was performed using DicomWorks 1.3.5 ( analysis software. Left ventricular end-diastolic diameter and end-systolic diameter were measured and used to calculate left ventricular fractional shortening (FS) by the following formula: FS(%)=[(EDD−ESD)/EDD]×100%.

    Pressure-Volume Loop Measurement

    Invasive steady-state hemodynamic measurements were performed (n=5 mice per group for MC-210, MC-Scr, and sham) at Week 4 as described previously.10 Briefly, after a midline neck incision, a 1.4-Fr conductance catheter (Millar Instruments, Houston, Texas) was introduced into the left ventricle through the right carotid artery. The signals were continuously recorded using a PV conductance system coupled to a PowerLab/4SP analog to digital converter (AD Instruments, Colorado Springs, Colo). Data were analyzed by using a cardiac PV analysis program (PVAN 3.4; Millar Instruments) and Chart/Scope Software (AD Instruments).

    In Vivo Optical Bioluminescence Imaging

    Bioluminescence imaging was performed using the IVIS Spectrum system (Caliper Life Sciences). Recipient mice were anesthetized with isoflurane and injected intraperitoneally with d-luciferin (200 mg/kg body weight). Mice were imaged before surgery (baseline scan) and after surgery on Day 3, Week 1, Week 2, Week 4, Week 6, and Week 8. Peak signals from a fixed region of interest were evaluated and signals expressed as photons per second per centimeter square per steradian (p/s/cm2/sr) as described.11

    Histological Examination

    After imaging, mice were euthanized and left ventricular tissue was obtained at 8 weeks after myocardial infarction (MI). Tissue samples were embedded into optimal cutting temperature compound (Miles Scientific). Frozen sections (5 μm thick) were processed for immunostaining. Trichrome stain (Masson; Sigma) was used to determine collagen content of the infarct regions. For each heart, 8 to 10 sections from apex to base (1.2 mm apart) were analyzed. Images were taken for each section to calculate the fibrotic and nonfibrotic areas as well as ventricular and septal wall thickness. Infarct fraction was determined as [fibrotic area/(fibrotic+nonfibrotic area)]×100% as previously described.9 To detect microvascular density in the peri-infarct area, a rat anti-CD31 (BD Pharmingen) was used. The number of capillary vessels was counted by a blinded investigator (Z.J.) in 10 randomly selected areas using the picture under a fluorescent microscope, as described previously.9 The formalin-fixed and paraffin-embedded explanted hearts were used for terminal deoxynucleotidyltransferase-mediated dUTP nick end labeling (TUNEL) assay. Nuclei undergoing apoptosis were stained with the DeadEnd Fluorometric TUNEL System (Promega) and the TUNEL-positive nuclei were counted and calculated as a percentage of all nuclei according to the manufacturer’s protocol. A subset of the mice (n=3 per group) was euthanized and the peri-infarct region of the left ventricle was dissected under stereoscope for Western blot analysis of Efna3 and Ptp1b.

    Target Confirmation by Immunoprecipitation of c-myc-Ago2-Containing RNA-Induced Silencing Complex

    Transient miR-210 overexpression was obtained by transfection of pSUPER-premiR-210 using Fugene6 (Roche) in HEK-239 cells (ATCC).12 Transfected cells were harvested in 1 mL per 15 dish of cold lysis buffer supplemented with 5 mmol/L dithiothreitol, 1 mmol/L phenylmethylsulfonyl fluoride, protease inhibitors mixture tablets (Roche), and 100 μm/mL of RNasin Plus (Promega). After 30 minutes at 4°C, samples were precleared by A/G-agarose beads (Santa Cruz) and spun at 4°C for 30 minutes at 20 000 g in a microcentrifuge. Next, the lysates were incubated at 4°C with 2.5 g/plate of antic-myc antibody (9E10; Santa Cruz) for 3 hours and then 50 μL/plate of A/G-agarose beads were added to each sample. After 1 hour, immunocomplexes were washed 2 times with lysis buffer and resuspended in 200 μL of TRIzol (Invitrogen). RNA was purified and specific mRNAs were measured by quantitative real-time polymerase chain reaction (PCR). Average values of 2 genes that were RNA-induced silencing complex (RISC)-associated but not miR-210 targets (B2M and RPL13) were used for normalization.13

    Statistical Analysis

    Statistics were calculated using SPSS 16.0 (SPSS Inc, Chicago, Ill). Descriptive statistics included mean and SE. One-way analysis of variance and 2-way repeated-measures analysis of variance with post hoc testing were used. Student or Welch t test was used depending on Levene test on variance homogeneity. If the probability value of the Levene test was >0.05, Student t test was used or else Welch t test was used. Differences were considered significant at probability values of <0.05.


    Induction of miR-210 by Hypoxia in Mouse HL-1 Cardiomyocytes

    To identify potential miRNA targets in our study, we first set up miRNA expression profiling experiment. Murine HL-1 cardiomyocytes were subject to hypoxia for 48 hours. Using fluorescence-activated cell sorting, we obtained 2 main populations of cells, apoptotic cells and live cells. We performed miRNA microarray on these 2 populations of cells using the Sanger miRBase Version 13.0 miRNA expression microarrays (LC Sciences, Houston, Texas). We analyzed 679 unique mature miRNAs across biological duplicates of each cell type and found that 7 miRNAs were significantly upregulated and 13 miRNAs were significantly downregulated in live cells compared with apoptotic cells. In particular, miRNA-210 was upregulated approximately 11-fold in live cells (Figure 1A). To confirm the results from miRNA microarray, we selected miR-210 and miR-1187 for real-time PCR analysis. Indeed, miR-210 was significantly upregulated in live cells (Figure 1B), whereas miR-1187 was significantly upregulated in apoptotic cells (Figure 1C). Mir-1187 has been found to be expressed in mouse embryo stem cells by high-throughput pyrosequencing, but its function has not been elucidated yet.14 We are more interested, however, in miR-210 because it has been shown to be associated with the angiogenesis-associated factor and antiapoptotic gene.6,15 To further assess whether hypoxia regulates miR-210 expression in cardiomyocytes, we also explored the time-course regulation of miR-210 in HL-1 cells. Induction of miR-210 by hypoxia was discernible at 12 hours of hypoxia, became statistically significant at 24 hours, and increased progressively to approximately 7-fold higher expression by 72 hours (Figure 1D).

    Figure 1. A, Schematic highlighting the miRNA microarray experimental design. HL-1 cells were subjected to hypoxia for 48 hours. After fluorescence-activated cell sorting, apoptotic cells and live cells were collected for miRNA microarray analysis. t test analysis demonstrates statistically significant differential miRNA expression across the 2 samples. miRNAs with P<0.05 were selected for cluster analysis. B, Quantitative reverse transcription–PCR showed miR-210 expression was 5.3±0.9-fold higher in live cells than in apoptotic cells. Welch t test was used. C, Quantitative reverse transcription–PCR showed miR-1187 expression was 8.4±0.9-fold higher in apoptotic cells compared with in live cells. Welch t test was used. D, Time course regulation of miR-210 by hypoxia in HL-1 cells. Induction of miR-210 was discernible at 12 hours, becoming significant at 24 hours and increased progressively at 48 and 72 hour time points. One-way analysis of variance was used. *P<0.01 and **P<0.05.

    Evaluation of miR-210 Proangiogenic and Antiapoptotic Functions in Cardiomyocytes

    To assess angiogenic potential of miR-210, HL-1 cells were transduced by a lentivirus-carrying miR-210 precursor (Pre-210) or by a lentivirus-carrying miR-scramble (Pre-Scr). Under fluorescence microscopy, nearly all the HL-1 cells were green fluorescent protein-positive in both groups, indicating no significant difference in transduction efficiency (Supplemental Figure II). Using real-time PCR analysis, miR-210 expression was 124±15-fold higher in the Pre-210 group compared with the Pre-Scr group. Figure 2A shows that HL-1 transduced with miR-210 could release several angiogenic factors compared with control cells, including Leptin,16 interleukin-1-α,17 and tumor necrosis factor-α.18 In addition, Pre-210 reduced caspase 3/7 activity in HL-1 cells compared with Pre-Scr control under both normoxia (1505 884±84 802 versus 649 933±32 309; P<0.01) and hypoxia (2832 896±97 509 versus 1886 473±48 009; P<0.01) conditions. Conversely, inhibition of miR-210 (anti-210) increased caspase 3/7 activity compared with control anti-Scr in both normoxia and hypoxia conditions (Figure 2B). Moreover, fluorescence-activated cell sorting analysis showed fewer apoptotic cells (22.13±0.48% versus 32.14±1.52%; P<0.05) and more live cells (71.95±1.69% versus 63.39±0.95%; P<0.05) in the Pre-210 group compared with the Pre-Scr group after 48 hours of hypoxia stress (Figure 2C). Taken together, these data demonstrate miR-210 can promote angiogenesis and inhibit apoptosis.

    Figure 2. In vitro characterization of therapeutic potential for miR-210. A, Angiogenesis antibody array indicated miR-210 can release several angiogenic factors in HL-1 cells. Welch t test was used for statistical analysis. B, Caspase 3/7 activity assay demonstrated that miR-210 overexpression could inhibit caspase activity, whereas inhibition of miR-210 with anti-210 abrogated the favorable effect. Student t test was used. C, fluorescence-activated cell sorting analysis confirmed that the miR-210-transduced group had more live cells (71.95±1.69% versus 63.39±0.95%; P<0.05) and less apoptotic cells (22.13±0.48% versus 32.14±1.52%; P<0.05). Student t test was used. *P<0.01 and **P<0.05.

    Improvement of Cardiac Function After MI After Injection of miR-210

    To examine whether miR-210 delivery can improve cardiac function after MI, nonviral minicircles were used to carry the miR-210 expression cassette (MC-210). As novel nonviral vectors, minicircles lack both an origin of replication and the antibiotic selection marker and carry only short bacterial sequences. Their smaller size confers greater transfection efficiency and the lack of bacterial backbone creates less immunogenicity and longer transgene expression.9 We first transfected HL-1 cells with different quantities of minicircles carrying Fluc-eGFP (MC-LG) in 6-well plate (Figure 3A). Data showed bioluminescence signals correlated robustly with in vitro Fluc enzyme activity (r2=0.96; Figure 3B). Next, to monitor the duration of transgene expression mediated by MC vector in living animals, a subset of animals with LAD ligation (n=5) were injected with 25 μg of MC-LG into the heart. In vivo bioluminescence imaging indicated that minicircle vector-mediated gene expression was stable for at least 8 weeks in the animal heart (Figure 3C–D). To examine whether MC-210 can improve cardiac function, adult FVB mice underwent LAD ligation and were injected intramyocardially with (1) MC-210; (2) MC-Scr (control); and (3) sham operated animals (n=15 per group). Echocardiography was performed before and after (Week 2, Week 4, and Week 8) the LAD ligation. At baseline, left ventricular FS was comparable in all 3 groups (Figure 4A–B; Supplemental Table I). After LAD ligation, the MC-210 group had significantly higher left ventricular FS compared with the MC-Scr group at Week 4 (28.7±2.4% versus 25.1±1.9%; P<0.05) and Week 8 (27.8±1.9% versus 24.2±2.7%; P<0.05). This finding was further corroborated using invasive PV loops. The PV loop data showed that left ventricular end-diastolic volume and end-systolic volume in the MC-210 group were significantly lower than MC-Scr group, suggesting a more favorable left ventricular remodeling process after miR-210 treatment (Supplemental Table II).

    Figure 3. Transfection efficiency of minicircle in vitro and in vivo. A, HL-1 cells were transfected with MC-Fluc-eGFP (MC-LG) in a 6-well plate. B, A robust correlation exists between minicircle dosage and bioluminescence signals (r2=0.96). Each data point is from an individual observation. Pearson correlation was used. (C), Bioluminescence imaging and (D) quantitative analysis indicate minicircle plasmid-mediated gene expression was stable for at least 8 weeks in the heart compared with <4 weeks using regular plasmid (data not shown).

    Figure 4. Evaluation of cardiac function after MI after miR-210 treatment. A, Representative echocardiogram of mice with LAD ligation after injection of MC-210, MC-Scr, or sham group at Week 8. B, Quantitative analysis of left ventricular FS among the 3 groups. Compared with the MC-Scr control, animals injected with MC-210 had significant improvements in FS values at both Week 4 and Week 8. Two-way analysis of variance was used for statistical analysis. C, Representative Masson trichrome staining of explanted heart at Week 8 showed increased wall thickness for the MC-210 group, confirming the positive functional imaging data seen in echocardiography. D, TUNEL staining of an explanted heart demonstrated significantly reduced apoptotic cells in MC-210 group compared with the MC-Scr control group. E, Immunofluorescence staining of CD31 endothelial marker (green) demonstrated increased neovascularization in the myocardium after MC-210 delivery compared with the MC-Scr control. Cardiomyocyte staining is identified by α-sarcomeric actin (red) and nuclear staining is identified by 4′,6-diamidino-2-phenylindole (blue).

    Ex Vivo Histological Confirmation of Echocardiographic Data

    After imaging, animals were euthanized and hearts explanted. Masson trichrome staining showed less infarction size for the MC-210 group compared with the MC-Scr group at Week 8 (Figure 4C), confirming the positive functional data seen in echocardiography. Calculated infarct fractions were significantly smaller in the MC-210 group compared with the MC-Scr group (26.5±2.4% versus 35.4±1.8%; P<0.05). TUNEL staining demonstrated significantly reduced apoptotic cells in the MC-210 group compared with the MC-Scr group (0.13±0.01% versus 0.22±0.04%; P<0.05), whereas few or no TUNEL-positive cells could be detected in the sham group (0.009±0.003%; Figure 4D). Finally, capillary status was evaluated by CD31 immunostaining in the peri-infarct areas (Figure 4E). Capillary density was significantly increased in the MC-210 group compared with the MC-Scr group after MI (362±25 versus 253±37 vessels/mm2, P<0.05).

    Prediction and Confirmation of Target Genes of miR-210

    To investigate the mechanism(s) of miR-210-based therapy, we predicted the target genes for miR-210 using both TargetScan and MicroCosm algorithms. Efna3, Dapk1, and Ctgf were predicted to be the putative target genes of miR-210 with high scores. The 3′-UTR segment of these 3 genes containing miR-210 putative binding site (“seed” sequence), which has a crucial role in miRNA:mRNA interaction, were very conserved in different species. Although it was reported that Ptp1b should be 1 of the miR-210 targets, the binding site was not in the 3′-UTR segment.13 To confirm that they are indeed the target genes of miR-210, the putative binding site of these target genes (Efna3, Ptp1b, Dapk1, and Ctgf) was amplified by PCR from mouse cDNA and inserted downstream of the luciferase reporter gene in the pGL3 control vector for dual-luciferase assay (Supplemental Figure III). After NIH/3T3 cells were cotransfected with reconstructive vectors and normalizing vector pRL-TK containing Renilla luciferase, the precursor miR-210 mimic (Pre-210) significantly reduced the luciferase activities of the wild-type Efna3, Ptp1b, Dapk1, and Ctgf reporters by 35% to 60% (P<0.05) compared with the miR-scramble (Pre-Scr) control (Figure 5A). In contrast, mutant reporters with 4 nucleotides mismatching noncomplementary seed binding sites were not repressed by miR-210 precursor, confirming that the target site directly mediates repression of the luciferase activity through seed-specific binding. Taken together, these results demonstrate that Efna3, Ptp1b, Dapk1, and Ctgf are the target genes of miR-210.

    Figure 5. Confirmation of the target gene of miR-210. A, The binding segments of mouse Efna3, Ptp1b, Dapk1, and Ctgf interacting with miR-210 was amplified and inserted downstream of firefly luciferase reporter gene in the pGL3 control vector for dual-luciferase assay (see Supplemental Figure III). pRL-TK containing renilla luciferase was cotransfected for data normalization. Precursor miR-210 mimic (Pre-210) significantly reduced the luciferase activities of the wild-type Efna3, Ptp1b, Dapk1, and Ctgf reporters between 35% and 60% compared with the PremiR scramble control (Pre-Scr). However, mutant reporters (Pre-210+Mut) with noncomplementary seed binding site were not repressed by miR-210 precursor as expected. The blank vector (PGL3-control) has no seed binding site and therefore the firefly luciferase activity was not affected by miR-210 precursor mimic. One-way analysis of variance was used. B, miR-210 targets were enriched in miR-210 containing RISC. Compared with cells transfected with a scramble sequence, immune precipitates of the miR-210 loaded RISC highly enriched its targets, including Efna3, Ptp1b, Dapk1, and Ctgf. Student t test was used. *P<0.05 and **P<0.01.

    To further demonstrate that they are direct miR-210 targets, biochemical assay based on the immunoprecipitation of RISC complexes enriched for miR-210 and its targets was used.13 To this end, a c-myc-tagged allele of Ago2, a core component of the RISC complex, was used. Easily transfectable HEK-293 cells were cotransfected with expression vectors for miR-210 and c-myc-Ago2, yielding cells enriched of miR-210/c-myc-Ago2-containing RISC complexes as well as miR-210 targets. We then immunoprecipitated c-myc-Ago2 and measured the levels of coimmunoprecipitated mRNAs by quantitative PCR. Background controls were represented by c-myc-immunoprecipitates derived from cells transfected with miR-210, but not c-myc-Ago2, and displayed low to undetectable signals for all the assayed genes (data not shown). Two known miR-210 targets (Efna3 and Ptpt1) were used as positive controls.12,19Figure 5B shows that Efna3, Ptp1b, Dapk1, and Ctgf were significantly enriched in immunoprecipitates of miR-210-overexpressing cells compared with cells transfected with a scramble sequence (Pre-Scr). We concluded that Efna3, Ptp1b, Dapk1, and Ctgf are all associated with miR-210 loaded RISC complexes and hence they are the real targets of miR-210.

    Endogenous Regulation of Efna3 and Ptp1b by miR-210

    Although these genes were identified as target genes for miR-210, it is still unknown whether miR-210 could regulate their expression endogenously. Because Efna3 and Ptp1b are involved in vascular remodeling and apoptosis in the heart, respectively, we selected these 2 genes for confirmation in HL-1 cells. HL-1 cells were transduced with Pre-210 to assess whether miR-210 could regulate endogenous Efna3 and Ptp1b. Compared with the control, the level of Efna3 mRNA was significantly downregulated by Pre-210 (Figure 6A) but not Ptp1b. However, we found the level of Ptp1b protein was downregulated on the Western blot (Figure 6B). These data suggest that endogenous Efna3 and Ptp1b are regulated by miR-210 at the level of mRNA and protein, respectively. Our data were also confirmed by immunofluorescence staining (Figure 6C). Furthermore, we also evaluated if miR-210 treatment in the heart would have an effect on Efna3 and Ptp1b. Western blot data from the peri-infarct regions of explanted hearts showed that Efna3 and Ptp1b in the MC-210 group are lower than in the MC-Scr group (Figure 6D). Taken together, these results suggest that overexpression of miR-210 led to downregulation of Efna3 on the mRNA level and downregulation of Ptp1b on the protein level. Efna3 is involved in inhibition of angiogenesis,12 whereas Ptp1b is involved in induction of apoptosis.20 Therefore, the suppression of these 2 targets by miR-210 delivery may contribute to the improvement of cardiac function after MI.

    Figure 6. Endogenous regulation of Efna3 and Ptp1b by miR-210. A, Quantitative reverse transcription–PCR indicates miR-210 can inhibit Efna3 but not Ptp1b at the RNA level. Student t test was used. B, However, Western blotting showed Ptp1b can be inhibited at the protein level instead. Student t test was used. C, Immunofluorescence confirmed miR-210 can strongly diminish Efna3 and Ptp1b expression in HL-1 cardiomyocytes. D, Western blot data show that Efnas and Ptp1b from the peri-infarct regions of explanted hearts are significantly lower in the MC-210 group compared with the MC-Scr group. Student t test was used. *P<0.05.


    Ischemic heart disease is the leading cause of human morbidity and mortality in the Western world, underscoring the need for innovative new therapies for heart disease. miRNAs are 21 to 23 nt noncoding small RNAs that act as negative regulators of the protein-coding gene by modulating the mRNA translation and stability.1,2 In this study, we report a novel therapeutic strategy for treatment of myocardial infarction based on miR-210. Using miRNA microarray analysis, we found that miR-210 was upregulated in live HL-1 cells compared with apoptotic cells after 48 hours of hypoxia challenge, suggesting that miR-210 possesses antiapoptotic properties during cell stress conditions. These data are also confirmed by a recent report indicating that miR-210 is induced in ischemia-preconditioned bone marrow-derived mesenchymal stem cells and that its suppression abolished the protective effects of preconditioning due to the abnormal expression of its target FLASH/caspase-8-associated protein-2, which can activate caspase 8 and facilitate apoptosis.15

    We also explored the time-course regulation of miR-210. Induction of miR-210 was discernible after 12 hours of hypoxia, and the upregulation was maintained for the next 72 hours. This predominant induction of miR-210 by hypoxia is consistent with reports involving other cell types such as embryo kidney cells, endothelial cells, breast carcinoma cells, colonic adenocarcinoma cells, and epithelial ovarian cells.7,12,21 The robust induction among various cell types is probably due to the highly conserved structure of hypoxia response element existing in miR-210 promoter.7 Under the diminished oxygen concentration of hypoxia, a variety of complex responses at both cellular and organism levels are activated, including endothelial cells proliferation, migration, and angiogenesis. The multiple lines of evidence prompted us to assess whether miR-210 delivery in vivo can improve heart function in a murine MI model.

    Besides the therapeutic gene, the success of cardiovascular gene therapy also depends on effective delivery systems to target sites. Here we used a nonviral minicircle vector carrying miRNA because of its multiple advantages, including greater transfection efficiency (compared with regular plasmids) and less immunogenicity (compared with viral vectors).9 miR-210 delivery through the minicircle vector improved left ventricular function after MI, and ex vivo histological analysis indicated that miR-210 induced neovascularization and inhibited apoptosis in ischemic hearts. Interestingly, previous studies have shown that miR-210 can improve tubulogenesis12 and prevent mesenchymal stem cell apoptosis.15 A recent study also reported that miR-210 can modulate mitochondrial respiration, iron metabolism, and reactive oxygen species generation during hypoxia by repressing iron–sulfur cluster assembly proteins to influence cellular adaptation to hypoxia, accounting for its benefits in ischemia.22 Therefore, miR-210 delivery after MI may have several pleiotropic effects in addition to the proangiogenesis and antiapoptosis roles that were investigated here.

    To study the potential molecular mechanism of miR-210 therapy in the heart, we performed an in silico search of potential targets using TargetScan and MicroCosm algorithms. We found several potential target genes for miR-210 after MI, including Efan3, Ptp1b, Dapk1, and Ctgf. Luciferase activities of these 4 putative wild-type target genes were downregulated by the miR-210 precursor (Pre-210) but not in mutant target sequences, suggesting that they are the real targets of miR-210 and that the inhibition was “seed” sequence-specific. Efna3 and Ptp1b are involved in inhibition of angiogenesis and induction of apoptosis, respectively. Efna3 suppression in human umbilical vein endothelial cells is vital for stimulation of tubulogenesis, indicating its crucial function in angiogenesis.12 Ppt1b is an ubiquitously expressed 50-Kda enzyme that is the most widely studied prototype for the protein tyrosine phosphatase superfamily. Recently, it has been reported that Ptp1b inhibition by siRNA significantly decreased apoptosis in cardiomyocyte.20 Ppt1b has also been implicated as a negative regulator in vascular endothelial growth factor signaling in endothelial cells.23 Dapk1, which encodes a proapoptotic serine/threonine kinase, is critical for regulating the cell cycle, apoptosis, and metastasis, mainly functioning in the early stages of eukaryotic programmed cell death.24 Ctgf is a secreted cysteine-rich protein with major roles in angiogenesis, chondrogenesis, osteogenesis, tissue repair, cancer, and fibrosis. Ctgf expression is enhanced in cardiac myocytes and fibroblasts in the heart after myocardial infarction25 and is induced by transforming growth factor-β in heart fibrosis.26 Thus, the inhibition by miR-210 delivery after MI may favor the functional improvement of left ventricle through direct inhibition of these target genes, especially Efna3 and Ptp1b as investigated in this study.

    In conclusion, we found that miR-210 can improve heart function by upregulating angiogenesis and inhibiting apoptosis. Because individual miRNAs can regulate the expression of multiple target genes, manipulating miRNA expression can influence an entire gene network and thereby modify complex disease pathology. Our approach shows that miR-210 delivery through nonviral minicircle may work as a novel therapeutic avenue for treatment of ischemic heart disease.

    Presented at the 2009 American Heart Association meeting in Orlanda, Fla, November 14–18, 2009.

    The online Data Supplement can be found with this article at

    We thank Dr Jarrett Rosenberg for assistance in biostatistical analysis.

    Sources of Funding

    This work was supported in part by grants from the National Institutes of Health (NIH) HL093172, NIH HL095571, Baxter Faculty Scholar Award (J.C.W.), AHA Postdoctoral fellowship (S.H.), and Italian Ministry of Health (Ministero della Salute; F.M.).




    Correspondence to Joseph C. Wu, MD, PhD, Stanford University School of Medicine, Grant Building S140, Stanford, CA 94305-5111. E-mail


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